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Objectives To examine changes in home healthcare service patterns in Japan during and after the COVID-19 pandemic and to assess the impact of the reclassification of COVID-19 as a category 5 infectious disease.Methods This retrospective study analysed claims data from Japan’s National Health Insurance database for home healthcare services in Kanagawa Prefecture between April 2014 and March 2024. We applied seasonal autoregressive integrated moving average models to calculate observed-to-expected (OE) ratios of service utilisation and used interrupted time series analysis to assess changes following the category 5 reclassification in May 2023.Results Home healthcare service utilisation consistently exceeded prepandemic projections during and after the pandemic, house call fees markedly increased during infection peaks (OE ratios up to +32%). In contrast, discharge coordination and long-term care support coordination instruction fees remained below projected levels, declining further during infection surges. Following the category 5 reclassification, several services exhibited significant positive level changes, whereas others showed negative trend shifts, indicating a potential stabilisation in growth rates.Conclusions COVID-19 accelerated the expansion of home healthcare services in Japan while reducing critical hospital-to-home transition services—effects that continued beyond the pandemic’s official conclusion. This pattern of quantitative expansion alongside qualitative gaps in care coordination underscores the need to build resilient home healthcare systems that preserve both service volume and care quality during future health emergencies.